Case 1
Clinical Presentation
A 24-year-old Hispanic male sustained a human bite on his right ear. He had a partial ear amputation involving the helical rim and a small portion of antihelix as well as their overlying skin ( Figs. 7.1 and 7.2 ). He was initially treated for the local wound and the open wound over his ear healed afterward ( Fig. 7.3 ). Appropriate reconstruction for the composite tissue loss of his right ear was obviously desirable.
Operative Plan and Special Considerations
Based on the size and location of the ear composite tissue defect, a cartilage graft would be needed for the ear’s frame reconstruction and a local skin flap would also be needed for coverage of the cartilage graft. A two-stage reconstruction was planned for this patient. During the first-stage reconstruction, the cartilage graft could be harvested from the contralateral ear and a local postauricular skin flap could be designed based on the postauricular skin as a random skin flap that would provide a skin coverage to the cartilage graft. During the second-stage reconstruction, the pedicle of the postauricular flap could be divided and a full-thickness skin graft from the supraclavicular region could be placed to close the postauricular donor site skin defect.
Operative Procedures
The first-stage reconstruction was performed under general anesthesia. The healed wound edge was reopened and refreshed with a knife. The size and shape of the cartilage defect was measured and a template was made. A contralateral ear cartilage graft was harvested from the concha via a posterior approach based on the template. Attention was paid to leave an adequate portion of the concha cartilage so that the shape of the contralateral concha could be maintained. The cartilage graft was then sutured in place with the remaining cartilage with interrupted 3-0 PDS sutures ( Fig. 7.4 ). The postauricular skin flap was designed and marked ( Fig. 7.5 ). Attention should be paid to make a wide enough skin flap to cover the cartilage graft and the flap itself should still receive adequate blood supply. The skin flap was inset and closed using interrupted 4-0 nylon sutures ( Fig. 7.6 ).
Four weeks later, the second-stage reconstruction was performed ( Fig. 7.7 ). Under general anesthesia, the skin pedicle at the base of the flap was clamped with a rubber band to assess whether the pedicle could be divided safely. After clamping for 5 minutes, the skin flap remained pink indicating that it could be divided without vascular compromise. The pedicle was then divided at the base of the flap and the postauricular open area of the flap was closed with interrupted 4-0 nylon sutures as much as possible. The rest of the open area was closed with a full-thickness skin graft harvested from the supraclavicular area and secured with a Xeroform tie-over dressing ( Fig. 7.8 ).
Follow-Up Results
The patient did well postoperatively without any complications related to his two-stage composite partial ear reconstruction. Both the postauricular skin flap and the cartilage graft sites healed well. The supraclavicular skin graft site also healed well without any problems ( Fig. 7.9 ).
